UMEM Educational Pearls

Category: Visual Diagnosis

Title: What's the Diagnosis? Case by Dr. Tejusve Rao

Posted: 9/8/2016 by Tu Carol Nguyen, DO (Emailed: 9/12/2016) (Updated: 9/12/2016)
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A 25-year-old male was brought in by EMS with a stab wound to the chest. What's the diagnosis?





CT Chest was done with the image below:

Penetrating Cardiac Trauma
  • Initial Assessment of ABC, ATLS primary survey guidelines.
  • Evaluate for tension pneumothorax or cardiac tamponade in all patients presenting with chest trauma and shock.
  • Cardiac Box: Surrounded by sternal notch, xiphoid process and nipples.
  • Order of injury: Right Ventricle --> Left Ventricle --> Right Atrium --> Left Atrium
  • Beck’s Triad: Hypotension, JVD, muffled heart sounds may not be present initially.
  • Conduct FAST exam to examine for cardiac tamponade, hemothorax, pneumothorax.
  • Cardiac Tamponade more common from stab wounds than from gun shot wounds.
  • Hemodynamically unstable patients require immediate operative therapy after quick bedside assessment (physical exam, ultrasound, chest tube as needed)

Differential Diagnosis: Bronchial injury, Diaphragm injury, Hemothorax, Tension Pneumothorax, Aortic Transection, Esophageal injury, Pneumomediastinum

Evaluation: Ultrasound (FAST Exam), CXR, CTA in stable patients, ECG, troponin.

Management: Penetrating cardiac trauma require emergent thoracotomy, pericardial window.



Clancy K, Velopulos C, Bilaniuk JW, et al. Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S301-6.

El-menyar A, Al thani H, Zarour A, Latifi R. Understanding traumatic blunt cardiac injury. Ann Card Anaesth. 2012;15(4):287-95.

Tintinalli's 7th Edition. Emergency Medicine Manual. Chapter 164: Cardiothoracic Trauma.